EP1617897B1 - Gerät zur identifizierung von elektrodenkombinationen in der neurostimulationstherapie - Google Patents

Gerät zur identifizierung von elektrodenkombinationen in der neurostimulationstherapie Download PDF

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Publication number
EP1617897B1
EP1617897B1 EP04705644A EP04705644A EP1617897B1 EP 1617897 B1 EP1617897 B1 EP 1617897B1 EP 04705644 A EP04705644 A EP 04705644A EP 04705644 A EP04705644 A EP 04705644A EP 1617897 B1 EP1617897 B1 EP 1617897B1
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EP
European Patent Office
Prior art keywords
electrodes
programmer
electrode
cathode
combination
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Expired - Lifetime
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EP04705644A
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English (en)
French (fr)
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EP1617897A1 (de
Inventor
Michael T. Lee
Steven M. Goetz
Nathan A. Torgerson
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Medtronic Inc
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Medtronic Inc
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/372—Arrangements in connection with the implantation of stimulators
    • A61N1/37211—Means for communicating with stimulators
    • A61N1/37235—Aspects of the external programmer
    • A61N1/37247—User interfaces, e.g. input or presentation means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
    • A61N1/3606—Implantable neurostimulators for stimulating central or peripheral nerve system adapted for a particular treatment
    • A61N1/36082—Cognitive or psychiatric applications, e.g. dementia or Alzheimer's disease
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3605—Implantable neurostimulators for stimulating central or peripheral nerve system
    • A61N1/36128—Control systems
    • A61N1/36146—Control systems specified by the stimulation parameters
    • A61N1/36182—Direction of the electrical field, e.g. with sleeve around stimulating electrode
    • A61N1/36185—Selection of the electrode configuration
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10S—TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S128/00—Surgery
    • Y10S128/903—Radio telemetry

Definitions

  • Implantable medical devices may be used to deliver neurostimulation therapy to patients to treat a variety of symptoms or conditions such as chronic pain, tremor, Parkinson's disease, epilepsy, incontinence, or gastroparesis.
  • An implantable medical device may deliver neurostimulation therapy via leads that include electrodes located proximate to the spinal cord, pelvic nerves, or stomach, or within the brain of a patient.
  • the implantable medical device delivers neurostimulation therapy in the form of electrical pulses.
  • the process of selecting values for the parameters that provide adequate results can be time consuming, and may require a great deal of trial and error before a "best" program is discovered.
  • the "best" program may be a program that is better in terms of clinical efficacy versus side effects experienced and power consumption than other programs tested.
  • the process of selecting electrodes and the polarities of the electrodes can be particularly time-consuming and tedious.
  • the clinician may need to test all possible combinations of electrodes within the set implanted in the patient, or a significant portion thereof, in order to identify a "best" combination of electrodes and their polarities.
  • the clinician may test combinations by manually specifying each combination to test based on intuition or some idiosyncratic methodology, and recording notes on the efficacy and side effects of each combination after delivery of stimulation via that combination. In this manner, the clinician is able to later compare and select from the tested combinations.
  • implantable medical devices commonly deliver spinal cord stimulation therapy (SCS) to a patient via two leads that include eight electrodes per lead and provide well over one million potential electrode combinations.
  • SCS spinal cord stimulation therapy
  • US 2002/0169484 and US 4,549,548 teach systems for selecting electrode combinations.
  • the invention is directed to a device as claimed in claim 1.
  • the device allows a clinician or patient to identify combinations of electrodes from within an electrode set implanted in a patient that enable delivery of desirable neurostimulation therapy by an implantable medical device.
  • the programmer may execute an electrode combination search algorithm to select combinations of electrodes to test in a non-random order. By selecting combinations in a non-random order, the programmer may allow the clinician or patient to more quickly identify desirable electrode combinations.
  • the programmer may identify a position of a first cathode electrode for subsequent combinations, and then select electrodes from the electrode set to test with the first cathode as anodes or additional cathodes based on the proximity of the electrodes to the first cathode.
  • the programmer may identify a first position within the electrode set, which may be a central position within the electrode set, and control the implantable medical device to test the electrode located at that position as the first cathode.
  • the programmer may then test additional electrodes from within the set as the first cathode in an order based on proximity to the first cathode.
  • the programmer may receive input from the clinician or patient indicating which tested electrode is the first cathode, and then control the implantable medical device to test other electrodes of the set in combination with the first cathode.
  • Undesignated electrodes may be tested as anodes and additional cathodes in an order based on proximity to the first cathode. In some cases, only a subset of the undesignated electrodes may be tested to avoid testing redundant electrode combinations, i.e., electrode combinations that would produce substantially the same current flow as an electrode combination already tested.
  • the programmer may store information for each combination tested, and the information may facilitate the identification of desirable electrode combinations by the clinician. For example, the programmer may present a list of tested combinations and their associated information, and the list may be ordered according to the information.
  • the clinician may create neurostimulation therapy programs that include identified desirable program combinations.
  • the first electrode may be a cathode for the combination.
  • a sequence of additional electrodes of the set to test for inclusion in the combination is automatically selected according to locations of the additional electrodes relative to the first electrode.
  • the additional electrodes may be tested for inclusion of one of the additional electrodes as an anode for the combination.
  • the device may be a programming device associated with one of a clinician and the patient.
  • a search algorithm is executed to control an implantable medical device to test combinations of electrodes in an order that is based on the proximity of the electrodes of the combinations to a central position within the set.
  • Information identifying at least one of the tested combinations is stored as part of a neurostimulation therapy program that defines neurostimulation therapy to be delivered to the patient by the implantable medical device.
  • the invention may provide a number of advantages. For example, the invention may allow a clinician to more quickly identify desirable electrode combinations, reducing the overall amount of time the clinician spends programming neurostimulation therapy for a patient.
  • programmer according to the invention may select electrode combinations in a systematic manner to test in an order such that electrode combinations that are more likely to enable desirable therapy are selected earlier in the search. Consequently, the clinician may be able to end the search before all potential electrode combinations have been tested if one or more desirable combinations have already been identified.
  • the invention may improve the search process by collecting amplitude information, and rating information that is entered by the clinician or patient, for each combination tested.
  • a programmer according to the invention may present a list of tested electrode combinations to the clinician, ordered according to one or both of the amplitude and rating information, allowing the clinician to more easily identify and select desirable combinations.
  • a bracket of untested electrode combinations that are similar to identified electrode combinations may be used to create programs that are provided to the patient. Providing bracket programs to the patient allows the patient to experiment with the programs to "finely tune" the neurostimulation therapy provided by the implantable medical device without requiring the clinician to be involved.
  • FIG. 1 is a diagram illustrating an example system for programming and delivering neurostimulation therapy.
  • FIG. 2 is a diagram illustrating an example electrode set that may be implanted within the patient.
  • FIGS. 6A-6K are diagrams illustrating example matrices that illustrate positions within exemplary electrode set configurations and orders in which electrodes within such electrode sets may be tested according to electrode combination search algorithms consistent with the invention.
  • FIG. 7 is a flow diagram illustrating an example method that may be employed by a programming device to test an electrode combination according to the invention.
  • IMD 14 delivers neurostimulation therapy to patient 12 according to one or more neurostimulation therapy programs.
  • a neurostimulation therapy program may include values for a number of parameters, and the parameter values define the neurostimulation therapy delivered according to that program.
  • the parameters may include pulse voltage or current amplitudes, pulse widths, pulse rates, and the like.
  • each of leads 16 includes electrodes (not shown in FIG. 1 ), and the parameters for a program may include information identifying which electrodes have been selected for delivery of pulses according to the program, and the polarities of the selected electrodes.
  • programmer 20 may reduce the time required to identify desirable electrode combinations by automating selection of each new combination to test. Additionally, programmer 20 may improve the search process by collecting amplitude and rating information for each combination tested. As will be described in greater detail below, programmer 20 may present a list of electrode combinations to the clinician, ordered according to one or both of the amplitude and rating information, allowing the clinician to more easily identify and select desirable combinations.
  • programmer 20 may communicate with IMD 14 via telemetry techniques known in the art.
  • programmer 20 may communicate with IMD 14 via an RF telemetry head (not shown).
  • Information identifying desirable combinations of electrodes identified by the clinician may be stored as part of neurostimulation therapy programs.
  • Neurostimulation therapy programs created by the clinician using programmer 20 may be transmitted to IMD 14 via telemetry, and/or may be transmitted to another programmer (not shown), e.g., a patient programmer, that is used by patient 12 to control the delivery of neurostimulation therapy by IMD 14.
  • programmer 20 may be used to identify desirable combinations of electrodes within electrode sets that are configured in any way, and used to provide any type neurostimulation therapy.
  • a single lead including four or eight electrodes, two leads including four electrodes per lead, in-line leads, and offset leads, all of which may be oriented in any manner relative to patient 12, provide electrode set configurations that may be searched by programmer 20.
  • an electrode combination electrons flow from the one or more electrodes acting as anodes for the combination to the one or more electrodes acting as cathodes for the combination.
  • the current between anodes and cathodes may stimulate neurons between and proximate to the anodes and cathodes.
  • an electrode combination enables desirable neurostimulation therapy when current is delivered in a direction and with an intensity sufficient to stimulate specific neurons or a sufficient number of specific neurons to alleviate a symptom without causing unacceptable side effects.
  • an electrode combination enables desirable neurostimulation therapy when the symptom is alleviated without resorting to undesirably high pulse amplitudes.
  • programmer 20 selects individual electrodes 40 or electrode combinations to test to allow a clinician to identify desirable electrode combinations according to an electrode search algorithm.
  • Programmer 20 may select an appropriate search algorithm based on the configuration of electrode set 42, and may select electrodes 40 or electrode combinations based on the selected search algorithm.
  • Programmer 20 controls IMD 14 to test a selected electrode 40 or electrode combination by controlling IMD 14 to deliver neurostimulation via the selected electrode 40 or combination.
  • Programmer 20 may first control IMD 14 to test one or more of electrodes 40 individually to identify the individual electrode or electrodes 40 which will act as a first cathode.
  • a clinician implants leads 16 in a location such that the center of electrode set 42 is proximate to an area that the clinician believes should be stimulated in order to alleviate symptoms. Therefore, programmer 20 may test electrodes 40 as the first cathode in an order such that electrodes 40 located centrally within electrode set 42, e.g., electrodes 40D-E and 40L-M illustrated in FIG. 2 , are tested before peripherally located electrodes.
  • Clinician programmer 20 also includes a memory 54.
  • Memory 54 may include program instructions that, when executed by processor 50, cause clinician programmer 20 to perform the functions ascribed to clinician programmer 20 herein.
  • processor may execute a selected one of electrode combination search algorithms 56 stored within memory 54 to select individual electrodes 40 or electrode combinations to test to allow the clinician to identify desirable electrode combinations.
  • processor 50 may collect information relating to tested electrode combinations, and store the information in memory 54 for later retrieval and review by the clinician to facilitate identification of desirable electrode combinations.
  • Neurostimulation therapy programs 60 created by the clinician may be stored in memory 54, and information identifying electrode combinations selected by the clinician to be utilized for one of programs 60 may be stored as part of the program within memory 54.
  • Memory 54 may include any volatile, non-volatile, fixed, removable, magnetic, optical, or electrical media, such as a RAM, ROM, CD-ROM, hard disk, removable magnetic disk, memory cards or sticks, NVRAM, EEPROM, flash memory, and the like.
  • Programmer 20 then, as will be described in greater detail below, executes the selected search algorithm to select individual electrodes 40 and electrode combinations to test (74).
  • programmer 20 may, as will also be described in greater detail below, store information 58 relating to that combination in memory 54.
  • the information may include amplitude information, and/or rating information provided by one or both of the clinician and patient 12.
  • FIG. 5A and 5B are flow diagrams illustrating an example electrode combination search algorithm that may be executed by programmer 20.
  • programmer 20 identifies an initial position within electrode set 42 (90), and controls IMD 14 to test an electrode 40 located at the initial position as the first cathode (92).
  • the initial position may be a central position within electrode set 42, and programmer 20 may identify a central position within set 42 based on the configuration of set 42.
  • programmer 20 may initially control IMD 14 to test electrode 40E ( FIG. 2 ) as the first cathode.
  • the clinician may identify the initial position or the specific electrode 40 that the clinician believes should be tested first, and programmer 20 may control IMD 14 to test the electrode 40 corresponding to input provided by the clinician.
  • Programmer 20 determines whether an additional electrode 40 should be tested as the first cathode (94). Programmer 20 may prompt the clinician to indicate whether an additional electrode 40 should be tested. If the clinician is satisfied with the first electrode 40 tested, programmer 20 identifies the first electrode as the first cathode for subsequently tested combinations (98). However, if the clinician indicates that additional electrodes 40 should be tested, programmer 20 may control IMD 14 to test additional electrodes 40 of electrode set 42 in an order based on decreasing proximity to the initial position until the clinician indicates that no more electrodes 40 should be tested or all electrodes 40 of electrode set 42 have been tested (96). At that point, programmer 20 may identify the first cathode (98) either as the last electrode 40 tested, or based on input from the clinician identifying which of the tested electrodes 40 should be identified as the first cathode.
  • programmer 20 controls IMD 14 to test one of electrodes 40 as the first cathode, another one of electrodes 40 adjacent to the tested electrode, or the can of IMD 14, acts as a first anode to form a cathode/anode pair.
  • programmer 20 may determine based on input received from the clinician whether other electrodes 40 of electrode set 42 are to be tested as the first anode (100). If the clinician indicates that no additional electrodes are to be tested as the first anode, programmer may identify the already tested electrode 40 adjacent to the first cathode as the first anode (104).
  • programmer 20 controls IMD 14 to test undesignated electrodes 40 of electrode set 42 in an order based on decreasing proximity to the first cathode (108) until programmer 20 receives an indication to stop testing electrodes 40 or until all electrodes 40 of electrode set 42 have been tested (110). If programmer 20 receives an indication to try an additional cathode (112), programmer 20 controls IMD 14 to test undesignated electrodes 40 of electrode set 42 in an order based on decreasing proximity to the first cathode (114) until programmer 20 receives an indication to stop testing electrodes 40 or until all electrodes 40 of electrode set 42 have been tested (116).
  • programmer 20 may create a bracket of untested combinations that the clinician may elect to include in neurostimulation therapy programs.
  • the bracket may consist of any number of electrode combinations, and may comprise the next n combinations that would have been tested according to the electrode combination search algorithm.
  • programmer 20 may allow clinician to spend less time searching for desirable electrode combinations.
  • the programs created using the bracket combinations may enable desirable neurostimulation therapy similar to that provided a program created with the most recently tested combination, and may be provided to patient 12 so that patient 12 can experiment with the bracket programs outside of the clinic.
  • Matrices 120, 130 and 140 of FIGS. 6A-C illustrate orders in which programmer 20 may select electrodes to test as the first cathode.
  • the "-" symbol in each of matrices 120, 130 and 140 indicates the initial position, i.e., the first electrode tested as the first cathode. Additional electrodes may be tested as a first cathode in the numeric orders illustrated, which illustrate examples of testing orders that are based on decreasing proximity to the initial position.
  • Matrices 150, 160, 170 and 180 of FIGS. 6D-G illustrate orders in which programmer 20 may select electrodes to test with an identified first cathode as the first anode.
  • the "-" symbol in each of matrices 150, 160, 170 and 180 indicates the identified position of the first cathode.
  • the "+" symbol in each of matrices 150, 160, 170 and 180 indicates the position of an electrode already tested with the first cathode as the first anode during the process of identifying the first cathode.
  • Other electrodes of an electrode set corresponding to one of matrices 150, 160, 170 and 180 may be tested as a first anode in the numeric orders illustrated, which illustrate examples of testing orders that are based on decreasing proximity to the identified first cathode.
  • Matrices 190, 200, 210 and 220 of FIGS. 6H-K illustrate orders in which programmer 20 may select electrodes to test with an identified first cathode/first anode pair as an additional anode.
  • the "-" symbol in each of matrices 190, 200, 210 and 220 indicates the identified position of the first cathode.
  • the "+" symbol in each of matrices 190, 200, 210 and 220 indicates the identified position of the first anode.
  • Programmer 20 may test other undesignated electrodes of an electrode set corresponding to one of matrices 190, 200, 210 and 220 as an additional anode in the numeric orders illustrated, which illustrate examples of testing orders that are based on decreasing proximity to the identified first cathode.
  • programmer 20 may test only a subset of the undesignated electrodes of an electrode set. Specifically, programmer may avoid testing electrodes as an additional anode that would provide substantially the same current flow as the first cathode/first anode pair due to the orientation of the additional anode and the first cathode/first anode pair. By testing only a subset of the undesignated electrodes and avoiding redundant combinations, programmer may further shorten the time required of the clinician to identify desirable electrode combinations.
  • programmer 20 may test electrodes within any type of electrode configuration. Further, configurations that include multiple additional anodes, or one or more additional cathodes may be tested. Whenever a cathode or anode is added, testing may be limited to a subset of undesignated electrodes in order to avoid redundant combinations.
  • FIG. 7 is a flow diagram illustrating an example method that may be employed by programmer 20 to test an electrode combination according to the invention. Specifically, FIG. 7 illustrates a method that may be employed by programmer 20 each time a new electrode is tested as a first or additional cathode, or first or additional anode. In other words, FIG. 7 illustrates a method that may be employed by programmer 20 each time programmer 20 identifies a new electrode combination to test (230).
  • Programmer 20 controls IMD 14 to test the combination by controlling IMD 14 to deliver neurostimulation therapy via the combination.
  • the clinician may select desired starting points for pulse amplitude, rate and width, and programmer 20 may ramp the amplitude from the starting point at a first rate of amplitude increase (232).
  • Programmer 20 may increase the amplitude in, for example, a linear or step-wise fashion.
  • the clinician or patient 12 may control the rate of amplitude increase.
  • the clinician or patient 12 stops the ramping of the amplitude when the stimulation causes discomfort, or other undesirable side effects (234).
  • Programmer 20 may reduce the amplitude at the time the ramp is stopped by some amount, e.g., a percentage, and ramps the amplitude again in order to allow the clinician and/or patient 12 to identify the amplitude that provides the best neurostimulation therapy (236, 238). This second time, programmer 20 may ramp the amplitude at a slower rate of amplitude increase in order to facilitate identification of the point where best neurostimulation is achieved. Again, in some embodiments, the clinician or patient 12 may control the amplitude.
  • some amount e.g., a percentage
  • the clinician may use rating information and/or the amplitude values stored for each tested combination to identify desirable combinations.
  • the combinations and their associated information and values may be presented in a list that may be ordered according to the information, the values, or a combination of the two.
  • the amplitude value may, for example, be used to distinguish between tested combinations with similar ratings based on the power that must be consumed in order for each combination to enable desirable neurostimulation therapy.
  • programmer 20 may take the form of any type of computing device, such as a laptop or desktop computer, may access resources, such as memory 54, via a computer network, such as a LAN, WAN, or the World Wide Web.
  • programmer 20 may include a plurality of computing devices, which may communicate to provide the functionality ascribed to programmer 20 herein via a computer network.
  • programmer 20 may be associated with patient 12, i.e., a patient programmer.
  • patient 12 may simply interact with programmer 20 in place of the clinician for some or all of the electrode combination identification process.
  • patient 12 may perform parts of the combination identification process without being supervised by the clinician, e.g., away from the clinic, using a patient programmer.

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Claims (10)

  1. Vorrichtung, mit einer Programmiereinrichtung (20), die konfiguriert ist, um eine erste Elektrode (40) einer Gruppe (42) von in einem Patienten implantierten Elektroden zu wählen, so dass diese in einer Kombination aus Elektroden als eine erste Katode für die Verwendung bei der Verabreichung einer Neurostimulationstherapie an den Patienten enthalten ist; dadurch gekennzeichnet, dass die Programmiereinrichtung (20) automatisch eine Folge zusätzlicher Elektroden der Gruppe in Übereinstimmung mit Orten der zusätzlichen Elektroden relativ zu der ersten Elektrode auswählt, um sie zusammen mit der ersten Katode für die Aufnahme in die Kombination von Elektroden als eine erste Anode zu testen.
  2. Vorrichtung nach Anspruch 1, wobei die Programmiereinrichtung eine Eingabe von einem Anwender empfängt, der die erste Elektrode identifiziert.
  3. Vorrichtung nach Anspruch 1 oder 2, wobei die Programmiereinrichtung eine anfängliche Position in der Gruppe identifiziert, die implantierbare medizinische Vorrichtung steuert, um eine der Elektroden zu testen, die sich an der Anfangsposition befindet, um sie in die Kombination als die erste Katode aufzunehmen, und die implantierbare medizinische Vorrichtung steuert, um zusätzliche Elektroden der Gruppe zu testen, um sie in die Kombination als die erste Katode in einer Reihenfolge aufzunehmen, die anhand der anfänglichen Position bestimmt ist.
  4. Vorrichtung nach Anspruch 3, wobei die Programmiereinrichtung eine Konfiguration der Elektrodengruppe identifiziert und die anfängliche Position anhand der Konfiguration identifiziert.
  5. Vorrichtung nach Anspruch 3, wobei die anfängliche Position eine Mittelposition in der Gruppe ist und die Programmiereinrichtung die implantierbare medizinische Vorrichtung steuert, um die zusätzlichen Elektroden in einer Reihenfolge zu testen, die auf einer abnehmenden Nähe der zusätzlichen Elektroden zu der anfänglichen Position beruht.
  6. Vorrichtung nach einem vorhergehenden Anspruch, wobei die Programmiereinrichtung eine implantierbare medizinische Vorrichtung steuert, um die zusätzlichen Elektroden in Übereinstimmung mit der Folge zu testen.
  7. Vorrichtung nach Anspruch 6, wobei die Programmiereinrichtung die implantierbare medizinische Vorrichtung steuert, um mehrere Kombinationen von Elektroden zu testen, wobei jede Kombination die erste Katode und wenigstens eine zusätzliche Elektrode enthält.
  8. Vorrichtung nach Anspruch 7, die ferner einen Speicher enthält, wobei die Programmiereinrichtung die implantierbare medizinische Vorrichtung steuert, um eine Kombination von Elektroden durch Steuern der implantierbaren medizinischen Vorrichtung, damit sie eine Neurostimulation über die Kombination von Elektroden verabreicht, durch Steuern der implantierbaren medizinischen Vorrichtung, um ein Amplitude der Neurostimulation zu erhöhen, bis von einem Anwender ein Hinweis zum Anhalten des Erhöhens der Amplitude empfangen wird, durch Speichern eines Werts der Amplitude zu einer Zeit, zu der der Hinweis von dem Anwender empfangen wird, als ein Amplitudenwert für die Kombination in dem Speicher und durch Speichern von Bewertungsinformationen, die von dem Anwender empfangen werden und die Effektivität der Verabreichung der Neurostimulation bei dem gespeicherten Amplitudenwert hinsichtlich der Adressierung von Symptomen des Patienten und/oder einen Grad von Nebenwirkungen, die durch die Verabreichung der Neurostimulation bei dem in dem Speicher gespeicherten Amplitudenwert als Bewertungsinformationen für die Kombination beschreiben, zu testen.
  9. Vorrichtung nach Anspruch 6, wobei die Programmiereinrichtung eine Untergruppe nicht bezeichneter Elektroden in der Gruppe anhand der Orientierung der nicht bezeichneten Elektroden bezüglich der ersten Katode und der ersten Anode identifiziert und die implantierbare medizinische Vorrichtung steuert, um Elektroden in der Untergruppe in einer Reihenfolge zu testen, die auf der abnehmenden Nähe der Elektroden in der Untergruppe zu der ersten Katode beruht.
  10. Vorrichtung nach Anspruch 1, wobei die Vorrichtung eine Programmierungsvorrichtung enthält, die einem Arzt oder dem Patienten zugeordnet ist.
EP04705644A 2003-04-25 2004-01-27 Gerät zur identifizierung von elektrodenkombinationen in der neurostimulationstherapie Expired - Lifetime EP1617897B1 (de)

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US10/424,194 US7463928B2 (en) 2003-04-25 2003-04-25 Identifying combinations of electrodes for neurostimulation therapy
PCT/US2004/002155 WO2004096349A1 (en) 2003-04-25 2004-01-27 Appartus for identifying combinations of electrodes for neurostimulation therapy

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EP1617897A1 EP1617897A1 (de) 2006-01-25
EP1617897B1 true EP1617897B1 (de) 2011-05-25

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US8649872B2 (en) 2014-02-11
US7463928B2 (en) 2008-12-09
US20040267330A1 (en) 2004-12-30
US20120078325A1 (en) 2012-03-29
EP1617897A1 (de) 2006-01-25
EP1617905A2 (de) 2006-01-25
WO2004096358A2 (en) 2004-11-11
WO2004096358A3 (en) 2005-01-27
US20040215288A1 (en) 2004-10-28
DE602004008905D1 (de) 2007-10-25
US20060195145A1 (en) 2006-08-31
ATE510583T1 (de) 2011-06-15
WO2004096349A1 (en) 2004-11-11
DE602004008905T2 (de) 2008-05-29
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